CMV pneumonitis

CMV pneumonitis

CMV pneumonitis Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating CMV pneumonitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies

Chest X Ray

• Chest x-ray (CXR) – findings present in most patients. Usually bilateral.

• Interstitial changes are most common
• Alveolar consolidation in ~25%
• Ground glass appearance may be present in some
• Nodular opacities in ~10%
• Pleural effusion in ~30%
• Adenopathy in ~10%
• Most patients with normal CXR will have findings on CT scan and gallium scan.

Differential Diagnosis

• Pneumonia due to bacteria
• Fungal infection
• Mycobacteria
• PCP (Pneumocystis carinii)

Risk Stratification and Prognosis

• Prognosis is poor. Particularly in significantly immunocompromised hosts, mortality from significant CMV pneumonitis may be greater than 50%.

Treatment

Pharmacotherapy

• Treatment is most commonly with ganciclovir 5 mg/kg q12h, though results are disappointing. BMT patients characteristically respond, but clinical response is quite variable in AIDS patients, inconsistently showing a significant benefit in different studies.

Transplantation

• Prophylaxis is now being used at some transplant centers. Options include CMV hyperimmune globulin or antiviral treatment such as ganciclovir.

Future or Investigational Therapies

• Trials of ganciclovir with CMV IgG have not shown a consistent benefit in all studies.
• Foscarnet is an alternative agent but data on its efficacy is lacking

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